General information only — not legal advice. Published by Edward & Amaury Solicitors, solicitors regulated by the SRA (no. 800525). How that affects what you read.

Medical Malpractice — No Win No Fee

United States (federal and general)Last reviewed 2 August 2026

Medical malpractice occurs when a healthcare provider's treatment falls below the accepted standard of care, causing injury to the patient. Most medical malpractice attorneys in the US work on a contingency fee basis, charging 33–40% of the recovery only if the case succeeds.

What Constitutes Medical Malpractice?

Direct Answer: Medical malpractice occurs when a healthcare provider deviates from the accepted standard of care, causing patient injury. Most medical malpractice attorneys work on contingency fees of 33⅓%–40%, though many states cap fees. Expert testimony is required in nearly all cases.

To establish a medical malpractice claim, a plaintiff must generally prove four elements: (1) a duty of care existed (a doctor-patient relationship), (2) the healthcare provider breached that duty by deviating from the accepted standard of care, (3) the breach caused the patient's injury (causation), and (4) the patient suffered actual damages as a result.

The "standard of care" is defined as the level and type of care that a reasonably competent healthcare provider, with similar training and in the same medical community, would have provided under the same circumstances. This standard is established through expert testimony.

Common Types of Medical Malpractice

  • Surgical errors — wrong-site surgery, retained foreign objects, nerve damage
  • Misdiagnosis or delayed diagnosis — failure to diagnose cancer, heart attack, or infection in a timely manner
  • Medication errors — wrong drug, wrong dose, dangerous interactions
  • Birth injuries — cerebral palsy, Erb's palsy, brachial plexus injuries
  • Anaesthesia errors — overdose, failure to monitor, allergic reactions
  • Hospital-acquired infections — negligent hygiene or sterilisation practices

Damages Caps by State

Many states impose caps on non-economic damages in medical malpractice cases. These caps limit the amount a plaintiff can recover for pain and suffering, regardless of what a jury awards. Notable examples include:

  • California (MICRA) — $350,000 for non-death cases, $500,000 for death cases (increasing annually from 2023)
  • Texas — $250,000 per defendant for non-economic damages, $500,000 aggregate for hospitals
  • Colorado — historically $300,000 for non-economic damages (adjustable for inflation; recent legislation is phasing in significant increases)
  • Florida — caps were struck down as unconstitutional in 2017 (no current cap)

Not all states have caps. States including New York, Pennsylvania, and New Jersey have no caps on non-economic damages in medical malpractice cases.

Contingency Fees in Medical Malpractice

Because medical malpractice cases are expensive to litigate — often requiring multiple expert witnesses, extensive medical record review, and lengthy discovery — attorneys are selective about which cases they accept. However, the contingency fee model remains standard, typically 33⅓% to 40% of the recovery.

Some states regulate contingency fees specifically for medical malpractice. New York's Judiciary Law § 474-a imposes a sliding scale: 30% of the first $250,000, 25% of the next $250,000, 20% of the next $500,000, 15% of the next $250,000, and 10% of amounts over $1,250,000.

Frequently Asked Questions

Where this applies: Contingency fee rules are set state by state. Check your own state's rules before acting.

Sources for this page

Every rule stated above is based on the primary sources below. Each link goes to the legislation, court rule or regulator itself so you can check it. Last verified 2 August 2026.

  1. Cal. Bus. & Prof. Code § 6146 (medical malpractice attorney fees) · in force from 1 January 2023

    As amended by AB 35 (Stats. 2022 ch. 17 § 2): 25% if settled before a complaint or arbitration demand is filed, 33% after. The former 40/33⅓/25/15 sliding scale no longer applies.

  2. N.Y. Judiciary Law § 474-a (medical malpractice fee schedule)

    Sliding scale: 30% of the first $250,000, descending to 10% above $1,250,000.

  3. Florida Bar News — Florida Supreme Court holds medical malpractice non-economic caps unconstitutional

    Estate of McCall v. United States (wrongful death) and North Broward Hospital District v. Kalitan (personal injury). Section 766.118 caps are not enforceable.

  4. ABA Model Rule 1.5 (Fees)

    Model, not law. Each state adopts its own version. Rule 1.5(d) bars contingency fees in most domestic relations matters and in criminal defence.

Who wrote and checked this page

Written and published by
Edward & Amaury Solicitors (Edward & Amaury Ltd, company no. 12195443), regulated by the Solicitors Regulation Authority under no. 800525.
Legal review
This page has not yet been through independent legal review. It is written from the primary sources listed below, which you can check directly.
Review dates
Last reviewed 2 August 2026. Next review due 2 February 2027.

Fee rules change. California’s medical malpractice fee limits changed on 1 January 2023, and the QOCS rules in England and Wales changed on 6 April 2023. If you spot something out of date, tell us — we publish corrections.

Where this applies: Contingency fee rules are set state by state. Check your own state's rules before acting.

Sources for this page

Every rule stated above is based on the primary sources below. Each link goes to the legislation, court rule or regulator itself so you can check it. Last verified 2 August 2026.

  1. ABA Model Rule 1.5 (Fees)

    Model, not law. Each state adopts its own version. Rule 1.5(d) bars contingency fees in most domestic relations matters and in criminal defence.

  2. Cornell LII — contingency fee
  3. Federal Rule of Civil Procedure 54(d) (costs to the prevailing party)

    A losing plaintiff may be ordered to pay the defendant's taxable costs. There is no US equivalent of QOCS.

Who wrote and checked this page

Written and published by
Edward & Amaury Solicitors (Edward & Amaury Ltd, company no. 12195443), regulated by the Solicitors Regulation Authority under no. 800525.
Legal review
This page has not yet been through independent legal review. It is written from the primary sources listed below, which you can check directly.
Review dates
Last reviewed 2 August 2026. Next review due 2 February 2027.

Fee rules change. California’s medical malpractice fee limits changed on 1 January 2023, and the QOCS rules in England and Wales changed on 6 April 2023. If you spot something out of date, tell us — we publish corrections.